Thanks for the reply! My Chiropractor said I had 3 ribs out of place. I let it go too long and had referred muscle pain in my lower back. I can get thru the run but swimming is the hardest (when I turn to breathe). Hopefully his adjustment will get me back in the game.

I'm glad the solution is easy so far, but the popped ribs shouldn't be considered normal. Frequent irritation of these joints may not be a necessary part of athletic activity, but it does help explain why athletes have a much higher incidence of costochondritis than the general population. To spare some potential chest pain in the future, I'd look into preventing the tension on these ribs in the first place. Possibly some problems in the Serratus, Intercostals, Obliques, or other muscles connected to the ribs, is pulling them out of place by resisting normal movement?

My kettlebell trainer also mentioned the intercostals when I commented on what I thought was muscle soreness, some time ago. Is it possible I was lifting kettlebells that were too heavy? I have since stopped using any weights due to pain and weakness on the left side as well as any body weight exercises. I am still able to swim, bike & run with minimal discomfort, but I agree, it is not normal. I can feel movement on the left side of my front rib cage when I do certain yoga poses. Thanks for your input and I welcome any other comments you may have.

While I have not personally used kettleballs, I have handled them and appreciate the concept. I think the allure for their use among endurance athletes has to be preservation of upper-body mass. I am very much impressed by the evidence that vigorous exercise, including weight-training, has tonic effects beyond the cosmetic, extending to better recovery from exercise, and the retarding of the aging process by affecting telemere shortening. Besides, it feels good. I guess if you are an endurance athlete, you might start out at a disadvantage when throwing any weight around, so there you probably have it. Hit the nail on the head.

What I find so fascinating about exercise physiology is that the things that are the best for us can often be the worst by a very small degree. It's a jeckyl and hyde thing, I suppose. Gotta watch that stuff! Going forward, what to do, since it appears to be a persistent problem. If you are familiar with some of my other posts, I often mention "trigger points" as a cause for recurring pains that don't seem to respond to rest, stretching, exercise, etc. You may have seen those plastic instruments displayed in the link I included in my earlier comment, on the case of the female volleyball player with recurrent chest pain, later diagnosed as costochondritis induced by years of athletic activity that involves, as I'm sure you've seen, a lot of reaching and straining to exert maximum force with ribs extended to their maximum reach. Most people go through their entire lives without using these muscles to that extent. Arguably, they aren't really designed well for repetitive use at maximum output, such as might be experienced by a volleyball player, or even a competitive swimmer. The unusual extent of use of these muscles more or less explains the confinement of symptoms to folks in these athletic categories, but an injury once sustained can come back to haunt over and over again, even when the former activities are abandoned. This is where the instruments, and trigger points, come into play.

While the case-history article discussed what was apparently "graston technique," to break down poorly remodeled recovered tissue, and kinesio taping as a lymphatic aid, I read more into the approach than what was covered there. What is in common with my approach is the presence of dysfunctional muscularature and a manual therapy to address it. The really good news is that a lot of muscular dysfunction merely involves stored tension in the muscles in question (trigger points, if you will), and the availability of techniques for disarming those dysfunctions, instruments not required (in most cases). Lots of cases of intercostal lock-ups can be solved by simply working the ends of your thumbs into the spaces between ribs that these muscles occupy, and releasing those knots. The muscles are very sensitive and do not require much pressure at all, just the introduction of this new stimulus. A varying amount of subsequent treatments often results in complete remission from these symptoms, when the normal flexion/extension of these tiny muscles is restored. What is probably happening right now, is that the intercostals (and/or many other muscles acting on the ribs) are immobilized after some minor injury that has long since healed, but persist in a holding pattern of limited movement. With respect to the authors of the article, I will allow that substantial scarring can produce the same results, but I doubt that you would experience that after cross-training with a kettleball. Trigger points, however, are quite likely.

I haven't much to add to James' in-depth analysis, but I did have a rib out of place once a few years ago, which manifested itself as a nasty stitch in my side. Fortunately my GP is also an osteo, so when I finally went in he popped it back into place and told me no weightlifting for a week, and I haven't had a probem since. I wasdoing BodyPump wasn't lifting very heavy weights, and I think the problem was actually caused in BodyCombat, a combination of all the twisting and not having very strong abs yet.

Thank you so much for your detailed reply! I have been seeing a chiropractor who also does Active Release Therapy. He has been working on the lats and intercostals. It is helping but seems to be a slow process. I still feel alot of movement under my left arm when I lift it for certain yoga poses (sun salutations). The pain is not severe anymore but I am avoiding plank position and pushups. I still don't feel strong enough yet. I am hoping once he has the muscles back to normal that they will hold the ribs in place and I can continue on. Does this method of treatment sound realistic? Thanks again for your input.

I think we are not there yet. Since there are 17 muscles attached to the shoulder blade, many of which are attached to the ribs, you may have to survive a good amount of whack-a-mole therapy before that shoulder and ribs move freely. Groups of muscles like this work synergistically and can lock up as a group, in support of a single member that may seem to have little to do with where you experience the problem. The symptoms you report when attempting the overhead motion confirm that it is likely to involve more than the muscles on the ribs themselves. In fact, they could be far down the line of dominoes from the source. I once worked with a chiropractor using ART, and had a chance to observe the technique close-hand, and see it implimented on several athletes. He was kind enough to explain the technique to me, even working on my own IT band, which was causing problems at the time.

One thing I noted about ART is the importance of movement during therapy. It is directed toward breaking adhesions between tissues that have improperly healed due to past trauma, which is something that affects many athletes. When excess collagen has been deposited at a particular site after inflammation has run its course, there is no guarantee the tissues involved will remain separated during this healing process. What was probably explained to you is that the same thing happens in deeper tissues that happens with scarring on the outside of the body. If two burned fingers are taped together during the healing process, they might actually be fused together as a result, requiring surgery to separate them. In ART the offending tissues are pinned by the practitioner during movement in order to force the fused tissues to separate by tearing the collagen bond between them. This of course requires movement during this process, but as any physical therapist can tell you, continued movement of the healing tissues is necessary to model the repair and prevent these adhesions from taking hold in the first place. ART, Graston, ASTYM, and other potentially painful techniques are used to remedy improper healing when the modeling failed or was not done. In many cases the injured athlete is unaware that an injury has healed in this way, and the therapies are used after the fact. This is possibly your case.

What I am concerned about is another potential problem that may have us barking up the wrong tree. If there is fixation of the joint(s) due to one or more of the muscles that interact with your shoulder, your ribs are simply recipients of this lack of flexibility. The problem may not be in the rib muscles at all, but simply affects them. If the Intercostals are actually moving freely (their range is very short), too much aggressive manipulation can actually tighten them. The massive Serratus (Anterior) muscle that runs from the back of the shoulder blade to 9 of your ribs can be responsible for the problem you have, since this muscle is sensitive to the twisting movements of swimming, crosstraining with a kettle ball, deep inhalation/exhalation, emotional stress, and coughing, all of which you may have encountered within a short span of time. The Teres muscles, S/I spinatus and Subscapularis also come into play. When I do shoulder work I usually have to address several of these synergists to get the group to relax enough for free movement to take place. I've had to do this on myself as well, since my profession is very shoulder-intensive.

While there is a certain amount of movement between tissues that can be isolated with a technique such as ART, some of these muscles move very little in any place that can be reached by such a technique. In addition, adhesions are only one problem an athlete can have in muscle or tendonous tissue. Muscles can remain in a state of contraction that prevents free movement even when there are no adhesions, and this problem is much more common. Not only is it common, but it is very easy to make worse with aggressive treatment, including pin-and-stretch techniques. In fact, muscles often remain in a contracted state to prevent painful movement, and until the muscles themselves are released (not the tissues between them), there may be no meaningful increase in function or range of motion. To complicate things further, a muscle may remain in a contracted state because another muscle in the group has a problem, so you can work on it all day without changing anything. When I talk about whack-a-mole, I imply that more diagnostic sleuthing may need to be done. This requires that each muscle in the group be isolated by an individual test for function, by somebody very familiar with the rotator cuff, which is something physical therapists (and some orthos and MDs) specialize in. When we find out what is not moving properly and transferring all movement to the ribs, we will know where to productively direct our efforts toward a permanent fix. Meanwhile, your chiro may be able to refer you to a good neuromuscular therapist for the time-consuming exploration of those other dozen or so muscles, possibly releasing them in the process. There is more than one way to rule out each of those 17 synergists.